Accountable Health Care

Sally Pipes cites a recent poll that has 60% of doctors opposed to Obamacare. The reason? She thinks the doctors are opposed to Obama’s attempt to nudge them toward Accountable Care Organizations, where doctors are encouraged to use “best practices” that have been established by electronic data over time instead of fee-for-service medicine, where doctors are paid each time they perform a test or a procedure. She thinks this is horrible. She is fabulously wrong. Last winter, I moved my parents from traditional fee-for-service Medicare to a nursing home that used doctors from the excellent Geisinger system, an Accountable Care Organization in central Pennsylvania. All of a sudden several things happened: people stopped sticking needles in my parents, who were in their last months of life; they stopped performing unnecessary and duplicative tests and procedures; and they started speaking to me in a completely candid, yet humane, manner about the best ways to let my parents pass on. It was an incredible experience, which I describe in some detail this week in the magazine, available online to subscribers and on newsstands Friday.

But Pipes has isolated the single most important reason why we’re spending way too much on Medicare: doctors love fee-for-service medicine. One wonders how doctors can love fee-for-service medicine and hate the federal deficit. They are one and the same problem.